Acute appendicitis, inflammatory appendiceal mass and the risk of a hidden malignant tumor: a systematic review of the literature

Abstract

IntroductionAcute appendicitis is significantly common. Despite the increased use of computed tomography, the number of perforated cases has been stable in the past three decades. Between 2% and 6% of patients with acute appendicitis present appendiceal mass, often described as inflammatory phlegmon or abscess. Malignant tumors are confirmed by pathological analysis in 0.9–1.4% of all appendectomies performed to treat acute appendicitis. However, recent series demonstrate an elevated incidence of malignancies, ranging from 5.9 to 12%, in patients with inflammatory appendiceal mass.MethodsThe analysis was based on a systematic review of the literature. The articles were searched in PubMed for the period from 1987 to 2016. Articles presenting the incidence of the hidden malignancy among patients with appendiceal inflammatory mass were selected. Variables as age, interval appendectomy rate, the incidence of neoplasm, time to surgery, minimally invasive assessment, histology, right colectomy rate and morbidity were analyzed.ResultsA total of 13.244 patients were described as presenting acute appendicitis. Appendiceal tumor is present in approximately 1% of the appendectomies, while the rate of neoplasm varies from 10 to 29% in patients presenting appendiceal inflammatory mass. Interval appendectomies, despite been the minority of the procedures, disregard the higher morbidity associated with right sided colectomies. The review of literature also describes oncologic, histologic and clinical aspects of patients presenting appendiceal neoplasm, describing the most frequent histologic subtypes of this illness.ConclusionHidden appendiceal neoplasm in acute appendicitis are rare, fortunately. However, its incidence is much higher in patients presenting appendiceal inflammatory mass. Hence, interval appendectomy should be considered in this subgroup of patients.

Appendiceal neoplasm risk associated with complicated acute appendicitis—a population based study

“…Appendiceal tumors are rare, usually incidental findings most often detected at histological evaluation of the removed appendix. Appendiceal neoplasm rate varies from 0.7 to 2.5% of appendectomy specimens in several large appendectomy series [7,[11][12][13]. With the development of precise diagnostic capabilities like CT, appendiceal tumors may increasingly be suspected on CT [14,15].…”

Appendiceal cancer masked as inflammatory appendicitis in the elderly, not an uncommon presentation (Surveillance Epidemiology and End Results (SEER)‐Medicare Analysis)

“…The SEER‐Medicare database is limited to only retrospective analysis and is subject to incomplete information secondary to clerical errors including erroneous coding or improper database entry. In addition, other studies have suggested that a prolonged duration of appendicitis, specific computed tomography (CT) findings or an atypical presentation may be suggestive of appendiceal cancer over inflammatory appendicitis, however, presentation data is not captured from the study database …”

Apendiks Tümörlerinin İnsidansı, Tedavisi ve Sağ Kalım: Retrospektif Bir Çalışma

“…A patient with mixt carcinoid adenocarcinoma was found to be 30% of The distribution performed surgical treatments of benign and malign appendiceal tumor types is given in 15 In a study conducted in our country, it was reported that the incidence of premalignant lesions and malign neoplasms in samples taken after appendectomy were 0.5 and 0.6, respectively. 16 In our study, the incidence of the malign appendiceal tumor was found to be quite low compared to other studies.…”